AWS for Industries
Building a serverless cloud-native EDI solution with AWS: Part 2
Adoption of electronic data interchange (EDI) in healthcare continues to improve the efficiency of electronic claims processing. However, organizations (like the American Medical Association) see an ongoing need to simplify healthcare EDI to make it easier for physicians and reduce uncertainty for patients.
Historically, implementation of EDI required complicated or monolithic legacy systems. To combat this, Amazon Web Services (AWS) launched AWS B2B Data Interchange to automate and transform EDI documents at scale. Customers can now build scalable EDI transaction processing systems using AWS B2B Data Interchange and other AWS services without the need to manage additional third-party software that requires server and license management.
Solution overview and architecture data flow
Healthcare Providers and Payors exchange data requests such as benefit enrollment, eligibility benefit verification, and claim encounter information. The following architecture illustrates how those requests flow between Providers and Payors, including inbound, outbound, and error-handling flows.
Figure 1. Architecture for inbound processing of EDI file
Inbound processing of EDI
1. Healthcare business partners securely transfer their EDI/X12 files with AWS Transfer Family. Example transactions include:
- Benefit Enrollment and Maintenance (834)
- Eligibility, Coverage or Benefit Inquiry (270)
- Health Care Claim (837)
- Health Care Claim Status Request (276)
2. AWS Transfer Family stores the incoming files in an Amazon Simple Storage Service (Amazon S3) bucket.
3. The incoming file creation causes Amazon S3 to send an Object Created event to AWS B2B Data Interchange. It parses the incoming EDI file, validates the EDI transactions according to HIPAA 5010 standards, and runs additional validations (refer to Validations section), including based on your business partner-specific rules.
4. AWS B2B Data Interchange next generates a TA1 interchange acknowledgement and a 999 functional acknowledgement. These are stored in the ACK folder of your output S3 bucket, underneath a business partner-specific folder.
5. AWS Transfer Family sends the acknowledgements to the business partner as they are placed in the ACK folder.
6. AWS B2B Data Interchange converts the inbound EDI to JSON or XML, applies your custom mapping template to transform the document, and uploads the output file to your output S3 bucket.
7. The Amazon S3 Object Created event notification triggers an AWS Lambda function.
8. The Lambda function loads the data to AWS HealthLake for further processing and analysis.
Figure 2. Architecture for outbound processing of EDI file
Outbound processing of EDI
1. AWS HealthLake generates an event that matches a desired event pattern.
2. This event triggers an AWS Lambda function to pull the data associated with the event from AWS HealthLake. It uploads the data to an S3 bucket as a JSON file.
3. The Lambda function invokes a StartTransformerJob API from AWS B2B Data Interchange. AWS B2B Data Interchange uses the JSON file and transforms it to your desired EDI output format based on your custom mapping. It populates the new EDI file in an S3 bucket, with folders for each trading capability and partnership.
4. AWS Transfer family sends the EDI file to the Healthcare partners through SFTP based on which partnership folder the file was put in.
Figure 3. Architecture for error handling and observability of inbound and outbound EDI file
Error Handling and Observability
1. AWS B2B Data Interchange runs validations on the inbound and outbound files.
2. AWS B2B Data Interchange sends any failed events to Amazon Simple Notification Service (Amazon SNS), which sends alerts to subscribed users, such as operators.
3. The users can view failed states and statuses in Amazon CloudWatch. The users can also build their own dashboards in CloudWatch for other error-related metrics.
Benefits
This solution provides two great benefits.
Validations
AWS B2B Data Interchange for EDI offers comprehensive HIPAA 5010 validation capabilities, confirming EDI transactions comply with Healthcare industry standards. It provides built-in compliance checks for various HIPAA 5010 transaction sets, validating syntax, structure, data elements, and inter-segment relationships.
The service performs transaction-specific validations, supports trading partner-specific rules, and validates against standard healthcare code sets. It generates detailed compliance reports, supports multiple HIPAA versions, and allows for customizable validation rules.
AWS B2B Data Interchange integrates seamlessly with other AWS services, enables near real-time validation, and automatically generates compliant acknowledgments. By leveraging these features, organizations can efficiently validate EDI transactions against HIPAA 5010 standards, reducing errors, rejections, and compliance risks in healthcare data exchanges.
Handling PII/PHI data
The EDI request and response file includes protected health information (PHI)/personal identifiable information (PII) data related to members, claims, and financial transactions. The solution leverages AWS services that are HIPAA eligible and encrypts data at rest and in-transit. The file transfers are through SFTP, and the on-premises request/response files are pretty good privacy (PGP) encrypted. The S3 buckets are secured through bucket access policies and are AES-256 encrypted.
Conclusion
AWS services like AWS B2B Data Interchange can be used to modernize and streamline healthcare EDI, making it more accessible and efficient for healthcare organizations of all sizes.
This solution leverages the power of cloud computing to overcome many of the challenges associated with traditional EDI systems, such as high costs, complexity, and scalability issues.
Contact an AWS Representative to know how we can help accelerate your business.